Pennsylvania has used a prescription drug monitoring program and database since 1972 and it’s due for an upgrade.
“Although it was a prescription monitoring system, it was woefully inadequate,” said Michael Zemaitis, a University of Pittsburgh pharmaceutical science professor.
Pennsylvania’s database was among the first in the nation, but only monitored highly addictive Schedule II drugs. Zemaitis said it was adversarial from the beginning while under the control of the state Attorney General’s office and data were only collected monthly. The information collected was also only available to law enforcement.
Though, officials with the Pennsylvania Department of Health said, by the end of August, a new prescription drug database will be up and running. While it may seem like an improvement, that deadline means it would still be more than a year overdue.
The legislative history
Zemaitis has worked to improve the state’s database law for nearly a decade. Though he’s seen bills die out from lack of interest, it eventually picked up steam in 2014 as the heroin epidemic grew – making it impossible for lawmakers to ignore, he said.
Eventually Act 191 of 2014 was signed into law, requiring a more robust reporting system scheduled to take effect June 30, 2015.
“First of all, it was passed without any budget consideration so it was doomed to wallow until it got a budget line,” Zemaitis said.
It did get funding in the 2015-16 budget, but the months-long stalemate stalled implementation of the budget until March 23, 2016.
Changes to the database
The program is no longer under the watch of the Attorney General and is now a part of the state’s Department of Health. It will track Schedule II through Schedule V drugs, meaning it loops in some of the less powerful medications like Xanax and Ambien that are often used by abusers in conjunction with stronger opioids and illegal drugs, like heroin.
Despite the fact that the growing heroin epidemic helped passage of the database law, as did the tie between heroin and prescription drugs, Department of Health Deputy Secretary for Health Innovation Lauren Hughes said the database is not officially intended to combat heroin abuse.
“Most importantly (it) will allow those that dispense these medications, and those that prescribe these medications, to help identify patients that may be suffering from the disease of addiction,” Hughes said. “(And) refer these patients to treatment services.”
It’s also not meant to nail doctors accused of running “pill mills,” but track and ultimately help individuals who might be hooked on prescription pain killers. Zemaitis said it’ll take more than just a database though.
“It’s certainly not going to quell the opioid epidemic,” Zemaitis said. “I’m convinced that the key to the problems that we have now is education at multiple levels.”
Implementation
The state continues to wrestle with implementation of the database. State officials signed a three-year contract with Kentucky-based Appriss Healthcare, which already works with 27 other states, to provide database management tools. Appriss Vice President of Business Development Brad Bauer said training tools are still being developed for Pennsylvania.
Pharmacist Jay Adzema, who owns Adzema Pharmacy in McCandless, said he hasn't heard much about what will happen.
“We don’t really know what’s going on, but we’ll be ready for it,” Adzema said. He also said he isn't surprised. “They never do, not until it’s done … Why tell us something that is going to change?”
Adzema said, though, he doesn’t foresee any of the changes being too burdensome – one of which will be reporting sales within 72 hours.
Most states with prescription drug database laws require daily reporting and a few states, including Oklahoma, are moving to real-time reporting.
The rules in Act 191 for doctors are bit looser. Physicians are required to check the database when writing a patient’s first narcotic prescription, but the law does not have rules on what to do if there is a history of multiple prescriptions. Doctors also do not have to check the database when they write prescriptions for ongoing treatment.
An algorithm will also generate reports when a sign of potential abuse is detected.
“So if they are getting prescriptions from a number of different pharmacies, being prescribed by a number of different doctors, escalating doses, these types of data points we’ll be able to pull reports from the system,” Hughes said.
Enforcement
It’s still unclear who will see the reports and what specific actions will be taken. In fact, the Pennsylvania Department of Health has no enforcement powers at this time.
“We’ll also be able to pull reports that identify prescribers that may have unusual prescribing behaviors,” Hughes said. “And we can take a look at those to determine if we need to provide education for those providers with regard to appropriate prescribing behaviors.”
Law enforcement agencies can ask for access to specific data, but must go through the courts or the state Attorney General’s office, depending on the request. Individuals will also be able to access their own records and the database will be reciprocally shared with all of the states that border Pennsylvania and 35 others.
Hughes said the state Department of Health is in the process of importing the data from the old system into the new database, otherwise the state’s prescription drug database will slowly grow, one entry at a time, starting in August.
Health care coverage on 90.5 WESA is made possible in part by a grant from the Jewish Healthcare Foundation.
